Download Credit Card Authorization Form

Credit Card Authorization Form
(Optional)
As stated in our engagement letter, we will require payment for our services before delivery of
your returns. For your convenience, we accept the major credit cards listed below as well as
personal checks and cash. You can also elect to pre-pay our agreed upon fee if you desire. Once
your return has been completed you will be notified and you may select your method of payment.
For your convenience you may also pay your invoice online once you have been notified of the
amount due.
Please fully complete the section below:
Today's Date: ______________________
Card Type:
Visa
MasterCard
Discover
American Express
Account Number_________________________________________________ _
Expiration Date: ________/_________
CVV Code __________
(on back of card)
Invoice/Charge Amount: _______________
Card Member Name: ______________________________________________
Company Name: _________________________________________________
Billing Address: _________________________________________________ _
Daytime Phone Number: ___________________________________________
Invoice #: _______________ Client Code/Name ________________________
Card Member’s Signature:
X___________________________________________________
By signing this form you authorize Stephenson & Warner to charge your credit/debit card
the amount indicated above. Also, you agree to pay this amount accordingly to the terms
and conditions of your credit/debit charge agreement.
Please fax the completed form to our office at 513-868-8620 or mail it to us. After
completion of your tax return the amount indicated will be charged to your credit/charge
card. Please call us at 513-868-8600 if you have any questions.
Thank you,
Stephenson & Warner, Inc.
IN HOUSE ONLY:
Date Charged:___________________
Initials:_______________________